And now:Ish <[EMAIL PROTECTED]> writes:
Shoalwater tribe sounds alarm over fetal deaths
P-I Plus: Seattle & Northwest
13 pregnancies in 2 years; 1 baby survives
Monday, February 22, 1999
By PAUL SHUKOVSKY <[EMAIL PROTECTED]>
SEATTLE POST-INTELLIGENCER REPORTER
TOKELAND -- Something is killing the future of the tiny Shoalwater
Bay Tribe. A generation is being wiped out in the womb, and nobody
knows why.
Among the southwest Washington tribe, 10 of 19 pregnancies
from 1988 through 1992 ended in miscarriage, ectopic pregnancy,
stillbirth or the death of the baby within a year of birth.
Of 13 pregnancies in 1997 and 1998, only one baby is alive
today. It is a statistic so startling that last month, a team of
investigators from the national Centers for Disease Control and
Prevention in Atlanta descended on this southwest Washington
reservation, where the Tokeland Peninsula points into the Pacific.
Part of the team's mission is to determine whether the miscarriages
and other complications of pregnancy are limited to the reservation or
also involve non-Indian residents of the region.
It's a recurrence of a scourge that tribal members thought
was behind them. In 1992, the tribe hit the panic button when
it realized that 10 of 19 pregnancies since 1988 had ended in
miscarriage, ectopic pregnancy, stillbirth or the death of the
baby within a year of birth. Although scientists and physicians
led by the federal Indian Health Service never pinpointed a cause,
people set aside their concerns when four apparently healthy babies
were born from 1993 through 1996.
Now the nightmare is back.
"If our people cannot keep their babies, our way of life here
will die," said Herbert "Ike" Whitish, chairman of the impoverished,
200-member tribe. "Most of them would have grown up to be my great-
nephews and -nieces -- the future of the tribe. It just feels like
if something isn't done, that this place will cease to be."
In the past two years, two women on the reservation have suffered
molar pregnancies, a condition in which the embryo dies quickly but
a group of precancerous cells continues to grow in the uterus, making
the woman think she is still pregnant. The condition is so rare that
having two cases in a tiny community "is clearly worrisome," said
Dr. William Freeman, director of research for the Indian Health
Service in Albuquerque, N.M.
Last year, there were seven miscarriages, one molar pregnancy and
one successful birth among the reservation community. In 1997, there
were two miscarriages, one molar pregnancy and one other fetal death.
This year, there has been one miscarriage and one baby whose 10-pound
birth weight could indicate problems such as gestational diabetes.
Typically, 30 percent to 40 percent of all pregnancies end in
miscarriage.
In Tokeland, tribal health department officers Gale Taylor and
Kim Zillyett spend many hours reviewing old charts and planning how
to improve medical surveillance of the tribe.
It's an especially tough task for Zillyett, who as one of those
who recently miscarried, is reminded of her loss at work every day.
"I'm one of those statistics, and I'm scared to death to try to
have another baby," she said.
Zillyett describes herself and her husband as working people who
take care of themselves and receive good medical care.
"Three days before it happened, we saw the heartbeat," she said.
"It doesn't make sense. Every single day since it happened, working
here is a constant reminder that I should be six months pregnant."
Now another member of her family is pregnant.
"It's going to be hard when she has her baby, because they should
be little cousins together," Zillyett said.
Picture | Parents Bonny and Shane Thomas cuddle 5-month-old Derek,
Parents | the only surviving baby of 13 pregnancies in 1997 and
& baby. | 1998 among the tiny Shoalwater Bay Tribe.
Anthony Bolante/P-I
Last month, Whitish sent a letter to members of the tribe that
began: "Some years ago, the Shoalwater Bay Tribe experienced a dark
time in its history -- the unprecedented high rate of infant deaths.
It saddens me to inform you that it appears that the problem has not
been overcome."
The letter drew no response from tribal members.
"People could not stand to confront the tragedy again," Taylor
said.
The next day, at the request of the tribe and the Pacific County
Commission, a four-member CDC team arrived on the reservation. When
the team got there, "The tension was so thick you could cut it with
a knife," Zillyett said.
Taylor said she "could see how hard this had hit the tribe. You
could see the pain of having to face it again."
Congress responded to the concerns in the early 1990s by
paying for construction of a health clinic staffed by a physician.
Federal and state agencies conducted studies to look for chemical
contaminants. They found high levels of pesticides in nearby
cranberry bogs, but made no direct connection to the fetal deaths.
For a while, many women of the tribe were afraid to become
pregnant. But when four healthy babies were born from 1993 to 1996,
tribal members put the bad times behind them.
So when the CDC team arrived last month, they were greeted with
gratitude as well as alarm.
The CDC doctors gave three briefings to tribal members on molar
pregnancies and miscarriages.
"It was very helpful and healing for the people around here to
actually go in and face their demon," Taylor said.
Whitish's wife, Teresa, a member of the Tulalip Tribe, believed
the Shoalwaters needed another kind of help to combat hopelessness
and despair.
She called on a shaman, who traveled to Tokeland with spirit
boards, a devining device phonetically pronounced squi-day-lich.
When the shaman read the boards, "The spirits revealed to him
that death was coming down in the form of rain," Teresa Whitish
said.
While no one else has pointed to rain as a possible cause,
experts from the Environmental Protection Agency and the state
Department of Ecology have studied the area around the reservation
for pesticide contamination.
Possible sources of pollutants surround the Shoalwater
Reservation, including an old military-weapons site that is
now a municipal dump. In addition, pesticides have been sprayed
on nearby commercial forest lands and cranberry bogs, and on
Willapa Bay to kill aquatic weeds and oyster parasites.
Officials have not identified any of these sources as responsible
for the deaths, and say making such a connection would be difficult.
"If they can't tell us what it is, we're looking for someone to
tell us what it's not," Ike Whitish said. "I'd like to hear that our
water is safe, that our land is safe, so we can have some comfort to
stay where we are at."
Reports released in 1997 by the EPA and the state Ecology
Department in response to the fetal deaths, while not exhaustive,
found only one unambiguous problem. There are high levels of
pesticide contamination in the drainage waters of the cranberry
bogs. The Ecology Department has worked with growers for years on
the problem. But there hasn't been much progress.
Levels of three pesticides in the cranberry drainage ditches --
guthion, lorsban and diazinon -- violate federal Clean Water Act
standards and, according to the DOE report, can kill aquatic life.
Gary Burns, the tribe's environmental program manager, says even
though studies have linked pesticides to reproductive problems in
animals, it would be difficult to connect the Shoalwater Tribe's
fetal deaths with the pesticide use.
"If there is an environmental link to this, we probably won't
make it," Burns said.
Members of an advisory board convened to help the tribe --
toxicologists, epidemiologists and physicians from federal and
state government -- agree that linking the environment and the
reproductive problems would be difficult. But they say the tribe
should do whatever is possible to minimize its exposure to
contaminants.
Dr. Roger Rochat, an epidemiologist with the CDC's Division
of Reproductive Health and a member of the team that visited the
reservation, said last week from Atlanta that at this early stage,
the team is not even looking for any tie between the environment
and the fetal deaths.
Rather, CDC scientists are gathering information on pregnancies
in the area to determine whether the miscarriages and molar
pregnancies are simply random or something more sinister.
But at least one expert thinks toxins could play a role.
The loss of genetic material in human ova that leads to molar
pregnancies could be caused by environmental factors, said Dr. Kurt
Benirschke, a nationally recognized expert on molar pregnancies and
diseases of the placenta.
"The real problem is to understand why there are eggs that don't
have a nucleus," he said. "People have considered the possibility
that this . . . is an environmental feature. I think that it is a
good possibility."
Authorities also are concerned that a cluster of molar pregnancies
might extend beyond the reservation.
When CDC scientists requested documentation of all molar
pregnancies and similar diagnoses from pathology labs in the region,
they learned that roughly 100 were reported during 1997 and 1998.
If all those were molar pregnancies, it would be roughly the number
one might expect for the entire state.
Benirschke says the U.S. incidence of molar pregnancies is one in
2,000 pregnancies. The CDC epidemiologists use a figure of one in
1,000 pregnancies. Washington state has about 55,000 births a year.
Benirschke says the incidence of molar pregnancies varies by
race and runs much higher among Asians. In Hong Kong, it is 1 in 242;
in Mexico, 1 in 200; in Sweden, 1 in 1,500. He called it a regular
occurrence in Japanese obstetric wards. But he knows of no data on
the incidence among Native Americans.
One problem is it is unclear what region the pathology reports
encompass. If the 100 instances are confirmed as molar pregnancies
that occurred in just a few counties in southwest Washington,
authorities would consider that evidence of a major problem. But
if many of the reports are incorrect, or the area covers much of
the state and into Oregon, there may be no problem at all. That's
what the CDC team wants to clarify.
Pacific County Health Department Director Kathy Spoor has been
deeply involved in collecting data for the CDC epidemiologists.
And she plans to improve medical surveillance to see whether the
reproductive problems run countywide.
There is an anecdotal sense that miscarriages have occurred at a
high rate in the county, she said. But until now, such data have not
been collected. Most miscarriages are not reported because state law
does not require it.
At a Feb. 5 meeting in SeaTac, experts from the CDC, the Indian
Health Service, the state Health Department, the EPA and the Pacific
County Health Department met with tribal leaders to address concerns.
As they discussed topics such as medical monitoring of women of
child-bearing age and preserving tissue samples from miscarriages,
tribal council member Lynn Clark responded by sharing the tribe's
sorrow.
"The whole community was suffering from a broken heart," Clark
said, recalling the first time the Shoalwaters faced these concerns.
"I hate to get back to it again, because it just opens up such a
big, huge void. It was too overwhelming. I can't do it. That's what
you guys are going to help us do -- move on."
Whitish, who rarely betrays emotion, winced as he heard Clark's
palpable pain.
He said: "We just can't sit and let things go on as they are and
hope they get better. If we are going to pass out of existence, at
least we want to go out fighting. That's the way our ancestors did
it. We want some truth. We want people to look at the data and tell
us what it means."
P-I reporter Paul Shukovsky can be reached at 206-448-8072
or [EMAIL PROTECTED]
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